The Latest from ATQ

Post type
Category

Below is a blog ATQ wrote for the Commissioning Better Outcomes (CBO) Evaluation site. ATQ is working with Ecorys on the CBO evaluation and co-wrote the Deep Dive report referred to.

pgoto from event

How do we improve the health of individuals, in a way that prevents health issues arising in the first place or getting worse? And how can Social Impact Bonds (SIBs) be developed in health and other areas where the benefits are longer term, with less immediate results and savings to the public purse?

These questions were at the heart of an event held last Friday (10 July) in Birmingham.  It brought together a range of stakeholders with a strong interest in improving the nation’s health, especially through the use of SIBs.

The event was hosted by the Big Lottery Fund, whose Commissioning Better Outcomes (CBO) Fund looks set to play a major role in encouraging more SIBs in the next few years. It was held to discuss a new SIB which breaks new ground in health and has just been examined in depth as part of the evaluation of…

View original post 701 more words

I have been struck by an article in Civil Society news today (9th February 2015) about the NPC manifesto, A Vision for Change.  There are two recommendations that rang a chord with me.

The first is that Trustees should be encouraged to focus more on how the charity pursues its mission and delivers beneficial outcomes rather than just on its survival.  In our work over the last twelve months with more than a dozen charities and social enterprises, my colleagues and I have been surprised how often Trustees who can be extremely entrepreneurial in their business and personal lives, become suddenly risk averse when acting as a Trustee.

The main result of this risk averse approach, in my view, is a long tail of sub-scale charities in almost all sectors but notably in military services and health sectors.  These all incur central overhead costs to run which could be saved, if the mission took precedence over survival, and Trustees considered mergers with other charities or more joint-working arrangements.

Most mergers in the charity sector appear to be emergency rescues when things have gone wrong rather than planned approaches with the aim of delivering more or better outcomes.   It takes a brave board of Trustees to make a strategic call such as continuing a charity’s mission through recommending a merger.  (As a Trustee myself with two charities, I admit I can see the challenge from the inside).  Clearly, finding a merger partner is potentially costly and ATQ’s response to the Cabinet Office’s 2014 consultation on sustainability included a recommendation that some funds be set aside to support charities seeking pro-actively to merge or take over others.

The second recommendation from A Vision for Change which I fully support is for a £30m ring fenced innovation fund.  The report argues that this should be a fixed proportion of BIG Lottery funds starting at 1% and rising to 5% over the next parliament.  Since we began working on social investment feasibility studies back in 2011, ATQ arrived at a similar conclusion.  If new public service innovative ideas are to be tested, then the monies need to be able to be ‘lost’ and so have to be set aside for that specific purpose and possibility.  No civil servant wants his or her career affected by commissioning an innovation that somehow fails.  Heaven forbid that they or their senior officers end up trying to explain how that could ever have happened to the Public Accounts Committee.

Many private organisations and indeed charities have equivalents to R&D budgets but somehow Government, despite all the challenges it faces, does not and this has surely hindered improvements in public services down the years.

An article in the Guardian today (12th November 2014) caught my eye – margaret-hodge-southwark-health-social-care  It was about Margaret Hodge MP, who chairs the Public Accounts Committee (PAC) and whose sometimes theatrical excoriation of both public and private sector managers has attracted much comment.

Now she is taking on the challenge of overseeing the implementation of changes in public services herself. She has started in the role of chair of the London Borough of Southwark’s “early action committee”. Its purpose is to re-organise services so as to intervene earlier and prevent social issues escalating and becoming more expensive to deal with later on.

As we know well from our social investment work and have commented on before, everyone agrees that this is the sensible approach to social inclusion problems but it has always proven very difficult to deliver – not least because in tightened times, budgets get drawn entirely into statutory provision leaving little or nothing spare for preventive work.

The article is pretty balanced and Mrs Hodge does of course, as the Guardian observes, have direct experience as a former leader of Islington Council – albeit nearly 30 years ago. So like the Guardian, I will watch with interest what lessons she learns from trying to lead a change herself rather than, along with her fellow PAC members, telling others what they think should have been done with the benefit of 20:20 hindsight.

When you are as old as I am, certain things start to come around again, and I am reminded how little there is that is genuinely new or untried in the realm of public sector service provision.

For example, as ATQ has blogged about before, Payment by Results was first tried in schools during Victorian times, which is before even my grandparent’s era.

My latest sense of déjà vu came this weekend when I read how Labour is likely to propose that public sector organisations should be allowed to freely compete and bid to deliver services – taking the model of the East Coast mainline train operator as an exemplar.

This reminded me of compulsory and voluntary competitive tendering (in local government) and market testing (in central government) which were used in the late 1980s/early 1990s as a way of using a competitive tender process to try and drive efficiencies and reform. The idea was for in-house teams to compete for the services that they were currently delivering. In this way, it forced an assessment of inputs vs outputs, how costs of services were made up and where changes could be made in working patterns and processes and so forth.

In local government competitive tendering was often a Thatcherite stick with which to beat left-wing Councils; while in many central government Departments, market testing was often a somewhat artificial process where the in-house team was never going to be replaced by a new provider and little benefit was derived. However, in some Departments and particularly in local government white and blue collar services, these processes led to noted improvements in in-house provision, and/or the outsourcing of services including through privatisation following management buy-outs. As a result, competitive tendering and market testing in many ways, set the public services industry ball rolling.

The world has moved on since then but similar exercises have taken place and are still underway. In 2010 and 2011, the NHS ‘right to request’ and ‘right to provide’ processes created new social enterprises for delivery of health services by previously in-house teams – which will have to compete for their ‘dowry’ contracts after five years.   According to the Department of Health some 40 services and 20,000 staff are now operating in such social enterprises. The creation of these new providers was highlighted as a factor in the growing proportion of services provided by non-NHS organisations in Nuffield Trusts recent (July 2014) report. http://www.nuffieldtrust.org.uk/publications/red-state-nhs-finances

The political philosophy arguments about use of non-public sector organisations in the delivery of public services remains a constant and has, over time, clearly influenced what type of organisation will win a contract award e.g. the increasing desire to make full use of the VCSE provider base. However, the underlying idea of ‘market testing’ is the same as it ever was.

Now that we are in a New Year, it’s apparent that both government and opposition are already thinking about the next election, and starting to make policy announcements and commitments.  For those of us who are focused on the world of government commissioning and contracting, one of the intriguing aspects of the next election is what an incoming government (if different) will do about this government’s major contracts for the delivery of public services.

Contracts which straddle governments are nothing new, of course, but what has changed is the type of contracts and the extent to which they impinge directly on policy.  While the outsourcing of any service can be controversial, in general few people tend to get too worked up these days about a contract for the delivery of back office support processes or information technology.  A new government will almost certainly continue such contracts largely unchanged, at least until the contract ends or reaches a suitable break point.

But in recent years, we have started to see governments use the private and third sectors to deliver social policies which a new government may want to change radically, or discontinue altogether.  The two obvious and large areas where this may be the case in 2015 are employability support and offender rehabilitation.  A brief look at both these areas shows some of the tricky dilemmas that are likely to arise for both the current government and the opposition.

To take employability first, the use of external contractors to deliver policy in this area is long established, and we have already seen what can happen to contracts after a change of government.  When the new government entered power in May 2010, it implemented the Conservative’s proposals for the Work Programme.  Since this was effectively an extension – to more client groups and with a larger role for external providers – of the Labour government’s Flexible New Deal (FnD), the policy was in the same “direction of travel”, as the saying goes.  But even so, all the existing contracts had to be terminated and an entirely new procurement process started.  So there was a significant cost – in both time and money – to put in place a very similar set of policy tools.

Since then the Work Programme has been heavily criticised by the opposition, and it can hardly leave it in place and untouched if elected.  But the cost of contract termination means that it may well continue the Programme at least until current contracts expire in March 2016 – although it will need to make clear its intentions well before that.

Offender rehabilitation is different, because there is no cross-party history of using external providers in this sector on a large scale.  The previous government dabbled in this area, but had little in place by way of contracted out provision.  In opposition the Labour Party seems to be broadly in favour of policies to reduce reoffending and rehabilitate offenders, but is strongly opposed to the means this government has adopted to achieve it, through its Transforming Rehabilitation proposals, which involve a mixed economy of public, private and voluntary sector provision that effectively outsources much of the current Probation Service.

So both government and opposition have big challenges ahead.  The government plans to have Transforming Rehabilitation contracts in place by April 2015, and knows that, with the next election fixed for May of the same year, it cannot afford any delay.  If contracts are not in place, it will be easier (though by no means painless) for a new government to reverse or significantly modify the policy.

However the opposition also has difficult issues to wrestle with.  If the government does meet its timetable, new Labour Ministers will have to decide whether they want to incur another large bill for contract termination, or can live with and try to modify the contracts to meet their policy objectives.  And as the election looms Labour will come under pressure to set out clearly what its policy is in this area – in a way that it probably would not have to do if private and third sector providers – and their investors – were not gearing up to deliver services.

In the longer term and if (as seems likely) the use of external providers in complex policy areas continues and grows, there are some bigger questions for government as a whole about how we avoid undermining the democratic process.  Politicians will rightly complain if their ability to change policy which is contentious is unduly constrained by the decisions of predecessors effectively to outsource delivery of said policy.  But those who are being asked to invest heavily in new provision – whether as providers or financiers – will be very reluctant to do so if there is no guarantee of continuity beyond each election cycle.  Some may say of the latter “so be it and good riddance” but most will not.

What may happen is one of two things, or possibly both.  First, more contracts will be awarded that are coterminous with general elections – something made easier if we stick with fixed five year terms. The second is that all parties will have to seek broader consensus on policy and the means to deliver it, before major programmes of service delivery outside the public sector are implemented.  This may be no bad thing, and has some precedent in our approach to major infrastructure projects, such as the 2012 Olympics and, more recently, HS2.  However since some in the Labour Party have been making noises about withdrawing support for HS2, a project which they first proposed, the auguries for the development of such consensus may not be that encouraging.